血糖、血压和血脂控制不佳的患者中糖尿病视网膜病变的患病率及危险因素。Sankara Nethralaya 糖尿病视网膜病变流行病学和分子遗传学研究（SN-DREAMS，报告 33）。

Prevalence and risk factors of diabetic retinopathy in subjects with suboptimal glycemic, blood pressure and lipid control. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, Report 33).

机构信息

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.

出版信息

Curr Eye Res. 2012 Jun;37(6):513-23. doi: 10.3109/02713683.2012.669005.

DOI:10.3109/02713683.2012.669005

PMID:22577770

Abstract

PURPOSE

To assess the rate of achieving optimal metabolic control among subjects with type 2 diabetes, to elucidate the influence of suboptimal control on diabetic retinopathy (DR) and to analyze the risk factors associated with DR in the subjects with suboptimal control.

MATERIAL AND METHODS

A population-based, cross-sectional study was conducted in south India. The study population consisted of 1414 subjects with type 2 diabetes. Optimal control of glycosylated hemoglobin (HbA1c), blood pressure (BP) and lipids was defined as: optimal HbA1c <7%, suboptimal HbA1c ≥ 7%; optimal BP ≤ 130/80 mm Hg, suboptimal BP >130/80 mm Hg; optimal low-density lipoprotein (LDL-C) <100 mg/dl, suboptimal LDL ≥ 100 mg/dl.

RESULTS

Of the subjects, 13.6% achieved combined optimal target levels for all metabolic parameters. When compared to subjects with optimal control, those with suboptimal control of HbA1c (trend P < 0.0001) and systolic blood pressure (SBP, trend P = 0.007) were more likely to have DR. Subjects having a combination of suboptimal glycemic and BP control (P < 0.0001 for SBP, P = 0.004 for diastolic blood pressure (DBP)), and suboptimal glycemic, BP and LDL control (P < 0.0001 for SBP, P = 0.017 for DBP), were more likely to have DR when compared to the subjects having optimal control of respective combinations. The factors associated with DR in the subjects with suboptimal control were younger age (P = 0.014 for BP, P = 0.016 for HbA1c), male gender (P = 0.035 for BP, P = 0.027 for HbA1c, P = 0.043 for LDL), presence of anemia (P = 0.021 for BP, P = 0.036 for HbA1c) and microalbuminuria (P < 0.0001 for both BP and HbA1c).

CONCLUSIONS

We found high prevalence of suboptimal metabolic control among subjects with type 2 diabetes. Suboptimal glycemic and SBP control, and their combination was the most detrimental for the development of DR.

摘要

目的

评估 2 型糖尿病患者达到最佳代谢控制的比率，阐明控制不佳对糖尿病视网膜病变（DR）的影响，并分析控制不佳患者中与 DR 相关的危险因素。

材料和方法

在印度南部进行了一项基于人群的横断面研究。研究人群包括 1414 名 2 型糖尿病患者。糖化血红蛋白（HbA1c）、血压（BP）和血脂的最佳控制定义为：HbA1c＜7%，控制不佳 HbA1c≥7%；BP≤130/80mmHg，控制不佳 BP＞130/80mmHg；LDL-C＜100mg/dl，控制不佳 LDL≥100mg/dl。

结果

在研究对象中，13.6%的人达到了所有代谢参数的联合最佳目标水平。与最佳控制组相比，HbA1c（趋势 P＜0.0001）和收缩压（SBP，趋势 P=0.007）控制不佳的患者更有可能患有 DR。同时存在血糖和 BP 控制不佳（SBP 差异有统计学意义，P＜0.0001；DBP 差异有统计学意义，P=0.004）以及血糖、BP 和 LDL 控制不佳（SBP 差异有统计学意义，P＜0.0001；DBP 差异有统计学意义，P=0.017）的患者发生 DR 的可能性高于各自组合中最佳控制的患者。在控制不佳的患者中，与 DR 相关的因素是年龄较小（BP 差异有统计学意义，P=0.014；HbA1c 差异有统计学意义，P=0.016）、男性（BP 差异有统计学意义，P=0.035；HbA1c 差异有统计学意义，P=0.027；LDL 差异有统计学意义，P=0.043）、贫血（BP 差异有统计学意义，P=0.021；HbA1c 差异有统计学意义，P=0.036）和微量白蛋白尿（BP 和 HbA1c 均有统计学意义，P＜0.0001）。